Information Technology, Quality and Population Health

Nurse-driven Telemetry Removal Protocol Now in Effect

As of August 1, the nurse-driven protocol to discontinue telemetry monitoring when the order expires went into effect. Previously, when the order for telemetry monitoring expired, patients remained on telemetry usually until discharged from the hospital. This at times has resulted in a scarcity of telemetry beds (especially on Dean 6 and Dean 7), prolonging unnecessary monitoring and impacting the patient experience.

Prior to this new protocol, the telemetry order set had been modified in a way that encourages guideline-based indications for telemetry. In addition, ED and resident physicians had received education regarding evidence-based utilization of telemetry. With that intervention, appropriate indications for telemetry utilization had increased to 85-95% throughout the hospital.

This next step is intended to safely remove telemetry when the order is expired and the patient no longer requires monitoring. The criteria that the RNs will follow to assess whether or not telemetry can be safely removed include the following:

  • 24 hours free from angina and negative troponin
  • No antiarrhythmic or antihypertensive medication started or dosage changed in the last 24 hours
  • No new cardiac arrhythmias for 24 hours
  • Free of symptomatic bradycardia/tachycardia for 24 hours
  • Magnesium and Potassium corrected and/or returned to normal
  • Systolic BP > 90
  • No syncopal episode in the last 24 hours
  • Digoxin level < 2.5

If ANY of the above criteria is NOT met, the nurse will renew the order for another 48 hours. If ALL of the criteria are met, the nurse will confirm with the monitor tech, remove the telemetry, and place a “sticky” note in Epic informing providers the order was allowed to discontinue and be removed. See full protocol.

There will likely be patients you want to remain on telemetry throughout their hospitalization regardless of the above criteria for discontinuation. Please note that when you order telemetry, the default is 2 days. however you can easily select Until D/C (until discontinued, see screenshot below), which will effectively keep the patient on telemetry monitoring until discharged from the hospital.